Currently, there are few studies on cost of care of childhood glaucoma. Our aim is to evaluate costs associated with childhood glaucoma upon diagnosis and during first 4 years of care.

Methods

Records of patients (pt) with primary congenital glaucoma (PCG) or secondary glaucoma (SG) who presented over a 15 year period to New Jersey Medical School were reviewed. Data was collected yearly after initial diagnosis; pts with at least 4 year follow up were included in the study. Best estimate at direct costs was based on total number of exams under anesthesia (EUA); surgical interventions including glaucoma procedures, cataract extractions, pars plana vitrectomies, or penetrating keratoplasties; all office and emergency department visits related to the patient’s glaucoma; and medications used. Hospital and physicians’ fees were converted to costs using the Healthcare Cost and Utilization Project charge to cost ratio of 0.65. Annual cost of medications was based on prior cost analysis. Indirect costs from productivity loss were ascertained by measuring caregivers’ missed work days, based on an 8 hour workday and average hourly wages plus benefits for civilian workers in the US ($29.18 per hour for all US companies).

Results

A total of 23 out of 60 pts diagnosed with childhood glaucoma met inclusion criteria. These consisted of 10 pts (19 eyes) with PCG, and 13 pts (20 eyes) with SG. Mean age at presentation was 41.1 months (from birth to 216 months) and 35.1 months (from birth to 240 months) in the PCG and SG groups respectively. Mean direct costs per pt in each group each year is included in Table 1. The only significant decrease was costs of surgical interventions between year 1 and year 2 (p<0.05). Costs of medications averaged $564.16 per pt per year. Models for calculating indirect costs of childhood glaucoma and visual impairment are not well-established. Average work days missed per pt per year was 8.39, averaging about $1,958.87 of lost wages per pt per year.

Conclusions

Childhood glaucomas pose a significant economic burden on care givers and the healthcare system. This burden was highest the first year after diagnosis, especially in cost of surgical intervention, but persisted during the 4 years included in this study. Direct costs are significant in the first years of the disease, however longer follow up is needed to evaluate the impact of indirect costs.